- Initial Statement of Beneficial Ownership (3)
September 26 2011 - 4:59PM
Edgar (US Regulatory)
FORM 3
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES
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OMB APPROVAL
OMB Number:
3235-0104
Expires:
November 30, 2011
Estimated average burden
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0.5
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Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(h) of the Investment Company Act of 1940
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1. Name and Address of Reporting Person
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Backus William A.
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2. Date of Event Requiring Statement (MM/DD/YYYY)
9/15/2011
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3. Issuer Name
and
Ticker or Trading Symbol
BALCHEM CORP [BCPC]
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(Last)
(First)
(Middle)
C/O BALCHEM CORPORATION, 52 SUNRISE PARK ROAD
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4. Relationship of Reporting Person(s) to Issuer (Check all applicable)
_____ Director
_____ 10% Owner
___
X
___ Officer (give title below)
_____ Other (specify below)
Chief Accounting Officer /
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(Street)
NEW HAMPTON, NY 10958
(City)
(State)
(Zip)
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5. If Amendment, Date Original Filed
(MM/DD/YYYY)
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6. Individual or Joint/Group Filing
(Check Applicable Line)
_
X
_ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person
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Table I - Non-Derivative Securities Beneficially Owned
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1.Title of Security
(Instr. 4)
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2. Amount of Securities Beneficially Owned
(Instr. 4)
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3. Ownership Form: Direct (D) or Indirect (I)
(Instr. 5)
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4. Nature of Indirect Beneficial Ownership
(Instr. 5)
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Common Stock
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2676
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I
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Held in 401(k) /profit sharing account
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Common Stock
(1)
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5030
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D
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Table II - Derivative Securities Beneficially Owned (
e.g.
, puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security
(Instr. 4)
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2. Date Exercisable and Expiration Date
(MM/DD/YYYY)
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3. Title and Amount of Securities Underlying Derivative Security
(Instr. 4)
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4. Conversion or Exercise Price of Derivative Security
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5. Ownership Form of Derivative Security: Direct (D) or Indirect (I)
(Instr. 5)
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6. Nature of Indirect Beneficial Ownership
(Instr. 5)
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Date Exercisable
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Expiration Date
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Title
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Amount or Number of Shares
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Employee Stock Option (right to buy)
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12/8/2007
(2)
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12/7/2016
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Common Stock
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4500
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$11.87
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D
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Employee Stock Option (right to buy)
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1/11/2009
(2)
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1/10/2018
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Common Stock
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12000
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$13.61
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D
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Employee Stock Option (right to buy)
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12/10/2009
(2)
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12/9/2018
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Common Stock
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15000
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$17.28
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D
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Employee Stock Option (right to buy)
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12/8/2010
(2)
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12/7/2019
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Common Stock
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12000
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$21.39
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D
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Employee Stock Option (right to buy)
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12/6/2011
(2)
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12/5/2020
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Common Stock
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14000
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$32.21
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D
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Employee Stock Option (right to buy)
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6/1/2012
(2)
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5/31/2021
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Common Stock
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5000
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$40.95
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D
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Explanation of Responses:
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(
1)
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This stock is subject to repurchase options in favor of the Issuer and to restrictions on transfer until is vests in accordance with the provisions of Restricted Stock Purchase Agreements, dated December 12, 2008; December 8, 2009; December 6, 2010; and June 1, 2011.
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(
2)
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Options vest 20% year 1; 40% year 2; and 40% year 3
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Reporting Owners
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Reporting Owner Name / Address
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Relationships
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Director
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10% Owner
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Officer
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Other
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Backus William A.
C/O BALCHEM CORPORATION
52 SUNRISE PARK ROAD
NEW HAMPTON, NY 10958
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Chief Accounting Officer
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Signatures
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/s/ William A. Backus, by Attorney in Fact, Matthew Houston
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9/26/2011
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**
Signature of Reporting Person
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Date
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
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*
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If the form is filed by more than one reporting person,
see
Instruction 5(b)(v).
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**
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Intentional misstatements or omissions of facts constitute Federal Criminal Violations.
See
18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
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Note:
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File three copies of this Form, one of which must be manually signed. If space is insufficient,
see
Instruction 6 for procedure.
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Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB control number.
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